| NPI | 1902262298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TN 217955) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: GA RN246632) |
| Enumeration Date | 2016-01-04 |
| Last Update Date | 2023-01-05 |